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Questions and Answers
What is a classic clinical manifestation of Superior Vena Cava Syndrome?
What is a classic clinical manifestation of Superior Vena Cava Syndrome?
Which treatment option is considered first-line for acute onset of Superior Vena Cava Syndrome?
Which treatment option is considered first-line for acute onset of Superior Vena Cava Syndrome?
Which of the following is NOT a common cause of Superior Vena Cava Syndrome?
Which of the following is NOT a common cause of Superior Vena Cava Syndrome?
What potential complication can result from untreated Superior Vena Cava Syndrome?
What potential complication can result from untreated Superior Vena Cava Syndrome?
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Which treatment must be used with caution due to its potential to decrease venous return?
Which treatment must be used with caution due to its potential to decrease venous return?
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What is a crucial nursing action for monitoring a patient with Tumor Lysis Syndrome?
What is a crucial nursing action for monitoring a patient with Tumor Lysis Syndrome?
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What symptom is NOT typically associated with Syndrome of Inappropriate Anti Diuretic Hormone (SIADH)?
What symptom is NOT typically associated with Syndrome of Inappropriate Anti Diuretic Hormone (SIADH)?
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Which treatment is recommended for correcting sodium-water imbalance in SIADH?
Which treatment is recommended for correcting sodium-water imbalance in SIADH?
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When monitoring a patient for Tumor Lysis Syndrome, which laboratory values should be checked frequently?
When monitoring a patient for Tumor Lysis Syndrome, which laboratory values should be checked frequently?
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What complication can arise from the excess secretion of ADH due to cancer cells?
What complication can arise from the excess secretion of ADH due to cancer cells?
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What is the nadir in relation to chemotherapy?
What is the nadir in relation to chemotherapy?
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Which absolute neutrophil count (ANC) range indicates moderate risk for infection?
Which absolute neutrophil count (ANC) range indicates moderate risk for infection?
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What is the primary nursing intervention to reduce the risk of infection in neutropenic patients?
What is the primary nursing intervention to reduce the risk of infection in neutropenic patients?
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Which of the following is a common cause of fever in oncology patients?
Which of the following is a common cause of fever in oncology patients?
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When calculating ANC, what formula is used?
When calculating ANC, what formula is used?
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What is the normal platelet count range in a healthy individual?
What is the normal platelet count range in a healthy individual?
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Which symptom might indicate severe neutropenia?
Which symptom might indicate severe neutropenia?
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What should patients with neutropenia avoid to decrease infection risk?
What should patients with neutropenia avoid to decrease infection risk?
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What is the recommended position for a patient with Superior Vena Cava Syndrome?
What is the recommended position for a patient with Superior Vena Cava Syndrome?
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Which of the following is a common manifestation of Spinal Cord Compression?
Which of the following is a common manifestation of Spinal Cord Compression?
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What initial treatment is commonly administered for suspected Spinal Cord Compression?
What initial treatment is commonly administered for suspected Spinal Cord Compression?
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Which of the following is NOT a recommended nursing assessment for a patient experiencing distress from Superior Vena Cava Syndrome?
Which of the following is NOT a recommended nursing assessment for a patient experiencing distress from Superior Vena Cava Syndrome?
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What is a potential cause of autonomic dysfunction in Spinal Cord Compression?
What is a potential cause of autonomic dysfunction in Spinal Cord Compression?
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Which diagnostic tool is considered the gold standard for diagnosing Spinal Cord Compression?
Which diagnostic tool is considered the gold standard for diagnosing Spinal Cord Compression?
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Which statement correctly describes a patient activity to be avoided in cases of Superior Vena Cava Syndrome?
Which statement correctly describes a patient activity to be avoided in cases of Superior Vena Cava Syndrome?
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What is a crucial monitoring component after a diagnosis of Spinal Cord Compression?
What is a crucial monitoring component after a diagnosis of Spinal Cord Compression?
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What is a serious risk associated with thrombocytopenia when platelet levels fall below 50,000?
What is a serious risk associated with thrombocytopenia when platelet levels fall below 50,000?
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Which of the following is NOT a common symptom of hypercalcemia?
Which of the following is NOT a common symptom of hypercalcemia?
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What initial treatment should be administered for mild or no symptoms of hypercalcemia?
What initial treatment should be administered for mild or no symptoms of hypercalcemia?
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What is a primary assessment finding in cases of tumor lysis syndrome?
What is a primary assessment finding in cases of tumor lysis syndrome?
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Which of the following indicates a severe case that may require hemodialysis during hypercalcemia treatment?
Which of the following indicates a severe case that may require hemodialysis during hypercalcemia treatment?
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What is an important nursing care consideration for patients with hypercalcemia?
What is an important nursing care consideration for patients with hypercalcemia?
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Which treatment is controversial when managing hypocalcemia in tumor lysis syndrome?
Which treatment is controversial when managing hypocalcemia in tumor lysis syndrome?
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What is the main symptom of anemia due to long-term chemotherapy and suppression of RBCs?
What is the main symptom of anemia due to long-term chemotherapy and suppression of RBCs?
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What type of diet may be required for patients with gastrointestinal concerns in thrombocytopenia?
What type of diet may be required for patients with gastrointestinal concerns in thrombocytopenia?
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What is NOT a recommended action for patients with thrombocytopenia to prevent bleeding?
What is NOT a recommended action for patients with thrombocytopenia to prevent bleeding?
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What are the common metabolic disturbances associated with tumor lysis syndrome?
What are the common metabolic disturbances associated with tumor lysis syndrome?
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Which EKG change might be observed in a patient experiencing hypercalcemia?
Which EKG change might be observed in a patient experiencing hypercalcemia?
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During hypercalcemia treatment, what is an effective approach to promote effective kidney excretion of calcium?
During hypercalcemia treatment, what is an effective approach to promote effective kidney excretion of calcium?
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Study Notes
Oncology Emergencies
- Myelosuppression encompasses various conditions affecting the bone marrow's ability to produce blood cells
- Neutropenia—low neutrophil count, increases infection risk. An ANC (Absolute Neutrophil Count) is used to assess the risk. Levels of 1500-1000 are considered low risk, 1000-500 moderate, and 500-0 high risk. Chemotherapy is frequently the cause.
- Thrombocytopenia—low platelet count. Normal count is 150,000-400,000. Platelet counts below 20,000 often necessitate transfusion.
- Anemia—reduced red blood cell count. Fatigue is a frequent symptom. Epoetin (Epogen, Procrit) may be utilized, in addition to rare red blood cell transfusions.
- Hypercalcemia—elevated blood calcium levels, common in metastatic bone diseases or multiple myeloma. Symptoms often arise when calcium levels exceed 12 mg/dL.
- Tumor Lysis Syndrome (TLS)—a metabolic complication resulting from rapid cancer cell death during treatment. This can lead to numerous complications including hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia.
- SIADH (Syndrome of Inappropriate Antidiuretic Hormone)—overproduction of ADH which leads to water retention and hyponatremia (low sodium).
- Superior Vena Cava Syndrome (SVCS)—obstruction of blood flow in the superior vena cava, often caused by tumors. Characterized by swelling of the face, neck, and upper body.
- Spinal Cord Compression—occurs when tumors compress the spinal cord or nerves. Extreme back pain and neurological symptoms are possible.
Neutropenia
- Neutrophils make up 50-60% of white blood cells (WBCs).
- Segmented neutrophils are mature WBCs; bands are immature neutrophils.
- Calculating ANC: [(segmented neutrophils + bands) / 100] x WBC count.
- Nursing Care for Neutropenia: Anticipate potential infections (pancultures), maintain hydration, administer antipyretics and antibiotics as needed, utilize colony-stimulating factors.
- Prevention is key, especially handwashing
Thrombocytopenia
- Low circulating platelets (normal 150,000-400,000).
- Nursing Care: anticipate bleeding issues (e.g., petechiae, bruising); platelet counts, PT, and PTT tests are required to monitor the patient. Platelet transfusions might be necessary for extremely low counts.
Hypercalcemia
- Assessment Findings: increased temperature, nausea and vomiting, polyuria, bone pain. constipation, hyporeflexia, seizures; can also present with decreased blood pressure and pulse, extreme thirst, anorexia, confusion, and EKG changes (often sinus bradycardia, prolonged PR, and shortened QT intervals). Renal failure is a potential serious complication.
- Treatment: Hydration, loop diuretics; potentially administering medications to inhibit bone breakdown or increase bone formation (e.g., calcitonin or biophosphonates such as pamidronate).
- Nursing Care: Daily labs (CMP/BMP and ionized calcium). Seizure precautions, neuro checks, vital signs monitored, daily weights, patient teaching regarding hydration, movement, and pulse monitoring.
Anemia
- Frequent symptom of long-term chemotherapy/radiation. Often caused by products of cell destruction, inflammatory response, medications, or malnutrition.
- RBC counts and growth factors (e.g., epoetin) are utilized for treatment.
Tumor Lysis Syndrome (TLS)
- Serious metabolic complication arising from cancer cell death.
- Symptoms include hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia.
- Treatment: ongoing hydration; stop IVs containing potassium, IV hypertonic glucose and insulin, IV calcium gluconate, or possibly kaexylate. Dialysis may be needed in extreme cases.
- Other treatment options exist for hyperuricemia (allopurinol) and hyperphosphatemia (phosphate-binding antacids).
- Nursing Care: frequent vital signs monitoring; input and output, weight checks, strict I&O monitoring; monitoring of serum electrolytes, BUN, Creatinine, and uric acid every 6-12 hours; also observation for symptoms of electrolyte imbalances.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
- Cancer cells or chemotherapy can cause excessive ADH leading Water retention and hyponatremia.
- Symptoms: weight gain without edema, personality changes, disorientation, decreased reflexes, generalized muscle weakness, seizures, and coma.
- Treatments: Fluid restriction, IV 3% saline in severe cases. Careful monitoring of sodium levels is crucial
Superior Vena Cava Syndrome (SVC)
- Blockage of the superior vena cava (vein returning blood to the heart). Symptoms often include swelling in the face and upper body, along with edema, dyspnea, and altered blood pressure between arms and legs
- Causes usually include tumors, masses, thrombi, or clots.
- Treatment: radiation therapy, chemotherapy to shrink tumors, possible stenting of the SVC. Anticoagulants as needed
Spinal Cord Compression
- Tumor pressing on the spinal cord, causing pain, weakness, and loss of sensation.
- Manifestations: intense back pain that is worse while lying down, exacerbated by coughing, sneezing, or straining, as well as motor weakness. sensory paresthesia (e.g., numbness, coldness), and loss of bowel/bladder function.
- Diagnosis: X-rays or MRI scan.
- Treatment: corticosteroids to reduce swelling, radiation therapy, and surgical intervention as needed.
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Description
Test your knowledge on various oncology emergencies such as myelosuppression, neutropenia, and tumor lysis syndrome. This quiz covers definitions, symptoms, and clinical implications related to low blood cell counts and other critical conditions in oncology. Enhance your understanding of these urgent medical situations in cancer care.
